ACA “ObamaCare”

ACA ("ObamaCare")

The Democratic-controlled Congress passed sweeping healthcare reform in 2009 through a unilateral effort[1] with a bill that mainly stated, “At the discretion of the Secretary of Health and Human Services (HHS)” and with the pronouncement of the Speaker of the House “If you want to know what’s in the bill, you have to pass it.”

The Patient Protection and Affordable Care Act (ACA, “Obamacare”) created some very popular concepts (e.g. elimination of pre-existing disease clauses that had prohibited some from health insurance; affordable insurance coverage for those previously uninsured) and some unpopular ones as well (e.g. mandated contraception and abortion coverage counter to religious beliefs; high-deductibles; new taxes).[2], [3]

At this writing the future of ACA is unclear. It appears that neither party in Congress has the political will to sit down together for the benefit of all and avoid the expected collapse of the current program.  However, it is clear that once Washington bureaucrats have their hand in a sector, it is hard to enact any entitlement reform.  So it is unlikely to see any changes out of Washington during 2017.



My Summary Analysis of the ACA ("ObamaCare")


  • Healthcare coverage for uninsured Americans
  • Inability to deny insurance due to preexisting conditions
  • Removal of life-time caps on coverage

The BAD:

  • Weight of over 128 new regulatory impacts/groups
  • Allowing no consequences to not buying insurance until the day you are sick (self-selection bias allowing healthy people to stay uninsured)
  • Delaying adulthood till age 26[4]
  • Increasing premiums and deductibles to working folks.
  • Burden on small businesses (see footnote #10 above).
  • Federal government thinking that one size fits all in a country of over 300 million.[5]


So what does this mean in the climate of Med Rec and how will it play out?

As I write this chapter, Congress is still addressing healthcare as a political issue and not an essential service. Perhaps they should step back and tackle a smaller portion, such as medication management. Through a bipartisan approach, they might find some common grounds for cooperation instead of the Nero-approach of each side fiddling while the exchanges burn, premiums skyrocket and the ACA collapses under its own weight.


[1] I note this since recently the minority leader of the Senate opined that the Republicans’ American Health Care Act (ACHA) was presented as a unilateral proposal and Americans deserve (and deserved) a bipartisan healthcare solution.

[2] Much to my dismay, as a small business owner (and to the disbelief of many of my colleagues who are in academics or employed by health systems), my monthly premiums went from less than $700 to nearly $1,300 and my deductibles from $2,000 to $7,000 in addition to all the new taxes on income and capital gains.

[3] In 2014 the aggregate small business impact of ACA was $1.9 billion and 11.3 million hours, while the national toll is estimated to be $49 billion and 190 million work-hours annually while costs are more than twice of expected (Sources:  American Action Forum and the Heritage Foundation, respectively).

[4] In all due respect, who wants their 25 year old unemployed and living in their basement.

[5] I warned you that I am a free-market Capitalist.

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